Chapter 54: Biological Response–Modifying and Antirheumatic Drugs

Humoral Immunity

Mediated by B-cell functions, primarily antibody production.

Cell-Mediated Immunity

Mediated by T-cell functions.

Biological Response–Modifying Drugs

Alter the body’s response to diseases like cancer and autoimmune, inflammatory, and infectious diseases.

Monoclonal Antibodies

Antibodies produced by identical plasma cells, used in treating cancer and autoimmune diseases.

Interferons

Proteins with antiviral, antitumour, and immunomodulating properties.

T-Helper Cells

Master controllers of the immune system, directing immune actions.

Cytotoxic T Cells

Kill their targets by causing cell lysis or rupture.

Colony-Stimulating Factors

Stimulate growth and maturation of neutrophils and other immune cells.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Provide analgesic effects and slow disease progression in rheumatoid arthritis.

Adjuvant

Immunostimulant drugs that work through nonspecific mechanisms.

Contraindications for Etanercept, Infliximab, and Adalimumab

Patients with heart failure, lymphoma, or MS should not use these drugs.

Pregnancy and Lactation Avoidance

Methotrexate, Tofacitinib, and Leflunomide should be avoided during pregnancy and lactation.

Initial Treatment Recommendation

Guidelines suggest starting with Methotrexate alone or with another DMARD for most patients.

Use of Biological DMARDs

Reserved for patients not responding to Methotrexate or combination DMARDs.

Assessment Before Medication Administration

Baseline assessments include vital signs, skin integrity, bowel and breath sounds.

Monitoring Intravenous and Subcutaneous Sites

Note chemotherapy-induced neutrophil nadir and potential joint or bone pain with Filgrastim use.

Assessment of Systems

Respiratory, cardiac, central nervous, and immune systems should be assessed before drug administration.

Interferons Administration Assessment

Assess for drug allergies, autoimmune disorders, hepatitis, liver failure, or AIDS history.

DMARDs Assessment

Evaluate past medical conditions, allergies, and medication profile before DMARD use.

Leflunomide Therapy Assessment

Assess hepatic function, blood cell counts, GI functioning, and bowel patterns before therapy.

Etanercept Assessment

Avoid in sepsis and active infections, assess WBC counts, signs of infection, and latex allergy.

Premedication for Biological DMARDs

Acetaminophen and diphenhydramine may be necessary to minimize allergic reactions.

Management of Bone Pain

Opioids, antihistamines, or anti-inflammatory drugs may be needed for bone pain with biological DMARDs.

Antiemetics Use

Consider antiemetics for drug-related nausea or vomiting before biological DMARD administration.

Monitoring for Infections

Vital signs monitoring, temperature, chills, and headache assessment due to infection risk with biological DMARDs.

Therapeutic Responses to Biological DMARDs

Include decreased lesion growth, improved blood counts, and symptom relief.

Expected DMARD Therapeutic Results

Increased joint mobility, reduced discomfort, and overall improvement in well-being within weeks.

Toxicity Manifestations

Liver, renal, respiratory dysfunction, and bone marrow suppression with Methotrexate.

Nursing Management for Biological DMARDs

Focus on aseptic technique, infection prevention, nutrition, blood count monitoring, and adverse effect management.